深圳市25家公立医院急性ST段抬高型心肌梗死救治基线调查

摘要

目的 初步了解深圳市公立医院急性ST段抬高型心肌梗死(STEMI)患者的救治现状.方法 在深圳市公立医院管理中心行政指令下,由深圳市人民医院胸痛救治质量管理与控制中心(以下简称"深圳市胸痛质控中心")牵头,选取深圳市25家公立医院[包括15家具备经皮冠状动脉介入治疗(PCI)医院和10家非PCI医院],进行胸痛救治医院综合条件和2015年10-12月STEMI患者救治情况的基线调查.结果 总计纳入深圳市25家公立医院2015年10-12月383例STEMI患者,其中15家PCI医院组324例,10家非PCI医院组59例.PCI医院根据心内科开放床位数均配备了相应数量心内科专科医师并设立有冠心病重症监护室(CCU).PCI医院组工作≥3年心内科专科医师人数[(18±6)人比(6±2)人,P<0.001],心内科床位数[(62±8)张比(25±3)张,P<0.001],CCU/心脏重症专用床位数[(6±4)张比(3±1)张,P=0.008]均显著高于非PCI医院组,差异均有统计学意义.两组医院均具备床旁完成18导联心电图(ECG)能力,首份ECG完成时间比较,差异无统计学意义(P=0.052).PCI医院在快速检测肌钙蛋白、D-二聚体(100.0%比30.0%,P=0.001),肌钙蛋白检测完成时间[(25.0±4.2)min比(58.0±2.8)min,P=0.002]均明显优越于非PCI医院组.而在建立ECG远程传输信息平台方面,非PCI医院组优于PCI医院组(80.0%比20.0%,P=0.005).PCI医院组建立完善的急性冠状动脉综合征(ACS)救治流程图(100.0%比80.0%,P=0.042),具备安装临时起搏器能力医院比例(100.0%比10.0%,P=0.002),配备安装主动脉内球囊反搏(IABP)能力的医院比例(80.0%比0,P=0.001)均优于非PCI医院组,差异均有统计学意义.PCI医院组STEMI患者到达医院至球囊开通最短时间为25 min,最长时间为720 min,平均时长为320.3 min;首次医疗接触至球囊开通最短时间为25 min,最长时间为856 min,平均时长为380.2 min;到达医院至溶栓开始(D-to-N)最短时间为70 min,最长时间为756 min.而非PCI医院组D-to-N最短时间20 min,最长350 min.因溶栓总病例数仅有8例,数量过少,未进行统计学分析.结论 非PCI医院在医院综合条件和胸痛救治水平较PCI医院差距大.%Objective To understand the treatment circumstance of ST-elevation myocardial Infarction (STEMI) patients at public hospitals in Shenzhen.Methods Directed by Public Hospital Administration at Shenzhen Municipality (PHASM) and led by Chest Pain Treatment Quality Control Center at Shenzhen People's Hospital (CPTQCC-SZ),25 public hospitals in Shenzhen, including 15 PCI-capable hospitals and 10 non-PCI-capable hospitals,we investigated on the overall treatment conditions and the STEMI patient treatment situations from October to December 2015 in these hospitals. A regression analysis was performed between a few factors and the success rate of STEMI treatment was reviewed. Results 383 STEMI cases twere registered between October to December 2015 in the 25 public hospitals in Shenzhen,with 324 case treated in PCI-capable hospitals and 59 cases in non-PCI-capable hospitals. There were statistical differences between the PCI-capable hospitals and non-PCI-capable hospital in fields of total number of senior cardiologists (work year ≥ 3 year),total number of beds in general cardiology beds and number of beds in cccu(all P<0.01). There was no difference in the time of obtaining the first ECG at patient arrival between hospitals(P=0.052).Time for laboratory results availability for troporin was significantly shorter in PCI-capable hospital[(25.0±4.2)min vs.(58.0±2.8)min,P=0.002] .Among the PCI-capable hospitals,the mean D-to-B time was 320 minutes, and mean F-to-B time was 380 minutes. In non-PCI-capable hospitals,D-to-N time ranged from 20 to 350 minutes and F-to-N time ranged from 25 to 380 minutes. Conclusions There are gaps among the overall conditions of the public hospitals in Shenzhen. The overall conditions and chest pain treatment conditions of non-PCI-capable hospitals had bigger gaps with PCI-capable hospitals.